Chronically ill, elderly, severely handicapped, and/or comatose patients sometimes require restraint and/or cushioning of the hands and forearms to prevent self-injury and/or to maintain a posture which will present or minimize the development of muscular atrophy, edema, decubitus, and/or acute pressure sores.
Severely debilitated patients often tend to assume a posture wherein their arms become folded or retracted against the anterior thorax and/or shoulders. If such posture is allowed to remain uncorrected for an extended period of time, the muscles of the arms and shoulders will begin to atrophy. Additionally, the constant positioning of the patient's hands adjacent the anterior thorax often results in repeated scratching (i.e. fingernail trauma) of the chest and neck area.
Additionally, in some patients who remain comatose or bedridden for extended periods of time, a condition known as "wrist drop" (syn. carpoptasis, drop hand) may result. Wrist drop is a muscular atrophy due to paralysis or non-use of the extensor muscles of the hand and fingers.
Also, in some patients edema of the hands and wrists may develop if their hands and arms are not maintained in an elevated posture. This problem of edema formation is especially prevalent in patients whose cardiac function is compromised (e.g. edematous changes which result from congestive heart failure).
Those who provide care to chronically ill, elderly, severely handicapped, or comatose patients often undertake to restrain or affix the patient's arms in positions which will help to retain normal muscle tone and prevent accidental trauma. Such restraint is typically accomplished through the use of straps or tape. For example, the forearms of an elderly patient may be loosely taped or bound to the arms of a wheelchair so as to prevent the arms from falling into the spokes of the wheelchair wheels and becoming injured thereby. Also, to prevent patients from scratching or injuring themselves, it is common practice to cushion the hands or to place a pillow on the patient's chest and to allow the patient's arms to retract against the pillow, thereby avoiding direct contact between the hands and the patient's body.
Although wheelchair "arm trays" and other orthotic appliances are available, such appliances are generally usable only in fixed locations (e.g., on the arm of a wheelchair) and do not generally attach to the patient's limb in a portable manner so as to permit the patient to move the limb about with the orthotic device remaining attached thereto.
Although these prior art methods and practices and devices may be somewhat helpful in preventing muscular atrophy, injury and/or edema, the common practice of taping or strapping the arms is known to be cumbersome and also tends to be somewhat imposing in appearance. Thus, there exists a need in the art for a simple device, attachable to the forearm, to effect restraint and shielding of the forearms/hands of a patient without the need for deployment of ties, cords, tapes, or the like. Additionally, it is desirable that such device be usable to accomplish orthosis of the entire pectoral limb, including the hand, wrist, arm, elbow, and shoulder.
In recognition of the aforementioned need, applicant developed the hand and forearm orthotic device disclosed in parent application Ser. No. 07/452,627 entitled "ORTHOTIC AND RESTRAINING DEVICE POSITIONABLE ON THE HAND AND FOREARM". This particular device generally comprises a block member having a strap member attached thereto to bind a forearm to the upper surface thereof. The block member has a generally wedge-shaped configuration such that when resting on a generally flat surface, the forearm is elevated such that the hand is higher than the remainder of the forearm. The device further includes a generally cylindrical hand grip adjustably attached to the block member via arcuate mounting members so as to permit varying degrees of dorsiflexion of the hand.
Though this particular device alleviates many of the shortcomings of the prior art, the device possesses certain deficiencies which detracts from its overall utility. One such deficiency is the inability of the device to permit varying degrees of rotation of the hand in addition to dorsiflexion. Further, due to the wedge-shaped configuration of the block member, the block member may not be used to maintain the forearm in a generally horizontal orientation unless such is affixed to a support member such as the armchair portion of a wheelchair. Additionally, the block member is not constructed so as to allow for the adjustment of the inclination angle of the patient's forearm. The present invention alleviates these and other deficiencies associated with the prior art, including the orthotic device disclosed in the parent application.